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Klinger-König J, Erhardt A, Streit F, Völker MP, Schulze MB, Keil T, Fricke J, Castell S, Klett-Tammen CJ, Pischon T, Karch A, Teismann H, Michels KB, Greiser KH, Becher H, Karrasch S, Ahrens W, Meinke-Franze C, Schipf S, Mikolajczyk R, Führer A, Brandes B, Schmidt B, Emmel C, Leitzmann M, Konzok J, Peters A, Obi N, Brenner H, Holleczek B, Moreno Velásquez I, Deckert J, Baune BT, Rietschel M, Berger K, Grabe HJ. Childhood Trauma and Somatic and Mental Illness in Adulthood. Dtsch Arztebl Int 2024; 121:1-8. [PMID: 37876295 PMCID: PMC10916765 DOI: 10.3238/arztebl.m2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Childhood trauma is associated with somatic and mental illness in adulthood. The strength of the association varies as a function of age, sex, and type of trauma. Pertinent studies to date have mainly focused on individual diseases. In this study, we investigate the association between childhood trauma and a multiplicity of somatic and mental illnesses in adulthood. METHODS Data from 156 807 NAKO Health Study participants were analyzed by means of logistic regressions, with adjustment for age, sex, years of education, and study site. The Childhood Trauma Screener differentiated between no/minor (n = 115 891) and moderate/severe childhood trauma (n = 40 916). The outcome variables were medical diagnoses of five somatic and two mental health conditions as stated in the clinical history. RESULTS Persons with childhood trauma were more likely to bear a diagnosis of all of the studied conditions: cancer (odds ratio [OR] = 1.10; 95% confidence interval: [1.05; 1.15]), myocardial infarction (OR = 1.13 [1.03; 1.24]), diabetes (OR = 1.16, [1.10; 1.23]), stroke (OR = 1.35 [1.23; 1.48]), chronic obstructive pulmonary disease (OR = 1.45 [1.38; 1.52]), depression (OR = 2.36 [2.29; 2.43]), and anxiety disorders (OR = 2.08 [2.00; 2.17]). All of these associations were stronger in younger persons, regardless of the nature of childhood trauma. Differences between the sexes were observed only for some of these associations. CONCLUSION Childhood trauma was associated with a higher probability of developing mental as well as somatic illness in adulthood. As childhood trauma is an element of individual history that the victim has little to no control over, and because the illnesses that can arise in adulthood in association with it are a heavy burden on the affected persons and on society, there is a need for research on these associations and for the development of preventive measures.
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Affiliation(s)
- Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maja P. Völker
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian State Office for Health and Food Safety, Erlangen, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
| | - Carolina J. Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
| | - Tobias Pischon
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Karin B. Michels
- Institute for Prevention and Tumor Epidemiology, Medical Center—University of Freiburg, Medical Faculty, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - K. Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Claudia Meinke-Franze
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- IInstitute of Medical Epidemiology, Biometry and Informatics, Profile Center Health Sciences, Medical School, Martin Luther University Halle-Wittenberg, Halle, Germany
- German Center for Mental Health (DZPG), Jena-Magdeburg-Halle Site, Halle, Germany
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Halle, Germany
| | - Amand Führer
- IInstitute of Medical Epidemiology, Biometry and Informatics, Profile Center Health Sciences, Medical School, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Medicine Essen, Essen, Germany
| | - Carina Emmel
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Medicine Essen, Essen, Germany
| | - Michael Leitzmann
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julian Konzok
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Anette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, LMU—Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Mental Health (DZPG), Munich site, Munich, Germany
| | - Nadia Obi
- Central Institute for Occupational Medicine and Maritime Medicine (ZfAM,) University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Saarbrücken, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Saarbrücken, Germany
| | | | - Ilais Moreno Velásquez
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard T. Baune
- Department of Psychiatry, University Hospital Münster, Münster, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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Greiser KH, Bohn B, Panreck L, Breunig E, Lieb W, Pischon T, Schikowski T, Völzke H. The German National Cohort (NAKO): Overview and Current State. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The presentation aims to give an overview of design, methods and first results of the German National Cohort (NAKO), the largest cohort study in Germany. NAKO is a multidisciplinary, population-based cohort study that provides a central resource for population-based epidemiologic research. NAKO aims to investigate the development and aetiology of diseases, identify risk factors and enhance early detection and prevention of diseases with a focus on diabetes, cancer, cardiovascular, pulmonary, neuropsychiatric and infectious diseases. Between 2014 and 2019, a total of 205,415 persons aged 20 - 74 years were recruited and examined at 18 study centres across Germany. The participants were invited to their local study centre to participate in a face-to-face interview, complete self-administered computer-based questionnaires, undergo a battery of biomedical examinations, and provide various biosamples. In addition, whole-body Magnet Resonance Imaging (MRI) was performed in 30,861 participants on dedicated 3 Tesla MRI scanners at 5 study centres. In 4-5 year intervals, all study participants are re-invited for examinations at the study centres. The programme for the first re-examination (including MRI scanning) was similar to the baseline programme. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. During the COVID-19 pandemic, questions on pandemic-related aspects including the history of infection, severity and long-term health impacts of COVID-19 were added to the examination programme. Since October 2018, 77,896 participants have been re-examined, including 11,382 with additional MRI examination. A supplemental COVID-19 questionnaire was completed by 161,849 participants of NAKO during the first COVID-19-related lockdown in Spring 2020.
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Affiliation(s)
- KH Greiser
- Department of Cancer Epidemiology, German Cancer Research Center , Heidelberg, Germany
| | - B Bohn
- NAKO e.V. , Heidelberg, Germany
| | | | - E Breunig
- NCT Coordination Office, German Cancer Research Center , Heidelberg, Germany
| | - W Lieb
- Institute of Epidemiology, Christian-Albrechts-University Kiel , Kiel, Germany
| | - T Pischon
- Max Delbrück Center for Molecular Medicine , Berlin, Germany
| | - T Schikowski
- IUF - Leibniz Institute for Environmental Medicine , Düsseldorf, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
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Peters A, Völzke H, Pischon T, Löffler M, Schmidt M, Albrecht M, Bohn B, Panreck L, Greiser KH. Die NAKO Gesundheitsstudie – Design, Methoden und Datennutzung für wissenschaftliche Auswertungen. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Peters
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH)
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich
| | - H Völzke
- Department of Community Medicine, University Medicine Greifswald
| | - T Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association, Molecular Epidemiology Research Group (MDC)
| | - M Löffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University Leipzig
| | - M Schmidt
- German Cancer Research Center (DKFZ)
| | | | | | | | - KH Greiser
- German Cancer Research Center (DKFZ)
- NAKO e.V
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Rudge G, Hartwig S, Sheldon M, Kluttig A, Sutcliffe R, Greiser KH. Developing a walkability metric to explore the association between built environment and walking behaviour in seven German cities. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Rudge
- University of Birmingham, Institute of Applied Health Research, Birmingham
| | - S Hartwig
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Halle (Saale)
| | - M Sheldon
- University of Birmingham, Institute of Applied Health Research, Birmingham
| | - A Kluttig
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Halle (Saale)
| | - R Sutcliffe
- Universitätsklinikum Essen, Zentrum für Urbane Epidemiologie, Essen
| | - KH Greiser
- Universität Heidelberg, German Cancer Research Centre Division of Cancer Epidemiology, Heidelberg
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5
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Hartwig S, Rudge G, Sheldon M, Greiser KH, Haerting J, Thürkow D, Kluttig A. P137 Methods of Assessment of Walkability and its Association with Physical Activity and Anthropometric Markers in a Population-based Study in the City of Halle (Saale). Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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6
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Medenwald D, Tiller D, Nuding S, Greiser KH, Kluttig A, Frantz S, Haerting J. Educational status and differences in left ventricular mass and ejection fraction - The role of BMI and parameters related to the metabolic syndrome: A longitudinal analysis from the population-based CARLA cohort. Nutr Metab Cardiovasc Dis 2016; 26:815-823. [PMID: 27397510 DOI: 10.1016/j.numecd.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Higher ventricular mass has been reported in non-white US-Americans with low educational status and in socially isolated people. To assess the impact of education on cardiac mass and function in the general population and to identify mediators. METHODS AND RESULTS Data from a German population-based sample were used (CARLA cohort, n = 1779 at baseline, n = 1436 at the four-year follow-up). Ventricular mass indexed on height (LVMI) and ejection fraction, using Teichholz's formula (EFTZ), were measured. Education was assessed using the ISCED classification. Mediator analyses were performed using the R-macro 'mediation' to compute the average direct effect and the average causal mediated effect after confounder adjustment. Sensitivity analyses for unobserved confounders were performed. Considered mediators were BMI, waist-to-hip ratio, HbA1c, and systolic and diastolic blood pressures. We found differences in LVMI and EFTZ, both at baseline and follow-up, between educational levels in women (lowest vs highest educational level: 15.6 g, 95% CI: -25.7, -5.6), but not in men. Similarly, women (lowest vs highest educational level at baseline: 3.3%, 95% CI: 0.8-5.7), but not men, of higher educational levels had a higher EFTZ of comparable magnitude at baseline and follow-up. Of the considered mediators, BMI explained 55.9% at baseline and 54.1% at follow-up of the educational effect, while other potential mediators had no significant effect. Relations remained constant between baseline and follow-up. CONCLUSIONS Women with low educational levels tend to have a higher ventricular mass and lower EF, which can be explained by a higher BMI in this group.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - D Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - S Nuding
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - K H Greiser
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - S Frantz
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - J Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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7
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Haftenberger M, Mensink GBM, Herzog B, Kluttig A, Greiser KH, Merz B, Nöthlings U, Schlesinger S, Vogt S, Thorand B, Peters A, Ittermann T, Völzke H, Schipf S, Neamat-Allah J, Kühn T, Kaaks R, Boeing H, Bachlechner U, Scheidt-Nave C, Schienkiewitz A. Changes in body weight and obesity status in German adults: results of seven population-based prospective studies. Eur J Clin Nutr 2015; 70:300-5. [PMID: 26508458 DOI: 10.1038/ejcn.2015.179] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to quantify body weight changes in German adult populations during the past decades. SUBJECTS/METHODS Longitudinal analysis of seven cohort studies covering different age ranges between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany. RESULTS Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women. CONCLUSIONS We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.
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Affiliation(s)
- M Haftenberger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - G B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - B Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K H Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B Merz
- Institute for Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - U Nöthlings
- Institute for Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - S Schlesinger
- Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - S Vogt
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - A Peters
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - T Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre of Cardiovascular Research, Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - S Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - J Neamat-Allah
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - U Bachlechner
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - C Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - A Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Medenwald D, Loppnow H, Kluttig A, Nuding S, Greiser KH, Thiery J, Tiller D, Herzog B, Werdan K, Haerting J. Educational level and chronic inflammation in the elderly--the role of obesity: results from the population-based CARLA study. Clin Obes 2015; 5:256-65. [PMID: 26230620 DOI: 10.1111/cob.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/29/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
This study aimed to assess the mediating role of anthropometric parameters in the relation of education and inflammation in the elderly. Cross-sectional data from the population-based CARdio-vascular Disease, Living and Ageing in Halle study were used after excluding subjects with a plasma level of high-sensitive C-reactive protein (hsCRP) above 10 mg L(-1) (916 men/760 women remaining). Education was categorized in accordance with International Standard Classification of Education. As inflammation parameters, the soluble tumour necrosis factor type 1 (sTNF-R1), hsCRP and interleukin 6 (IL-6) were taken into account. Anthropometric parameters were the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHeR). We used covariate adjusted mixed models to assess associations. Effect measures were the natural indirect effect (NIE), controlled direct effect and total effect (TE). Education was associated with sTNF-R1, hsCRP and IL-6 in men, and sTNF-R1 and hsCRP in women. Anthropometric parameters correlated with all inflammation parameters after covariate adjustment. BMI and WHeR were strong mediators of educational differences in sTNF-R1 (percentage of NIE of TE: 28% in men; 33% in women) and hsCRP (percentage of NIE of TE: 35% in men; 52% in women), while WHR was the weakest mediator. General obesity mediates roughly one-third of the association of education with chronic inflammation in the elderly.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - H Loppnow
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - S Nuding
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K H Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - J Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - D Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - B Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Müller G, Wellmann J, Hartwig S, Greiser KH, Moebus S, Jöckel KH, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K. Association of neighbourhood unemployment rate with incident Type 2 diabetes mellitus in five German regions. Diabet Med 2015; 32:1017-22. [PMID: 25440771 DOI: 10.1111/dme.12652] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 01/28/2023]
Abstract
AIM To analyse the association of neighbourhood unemployment with incident self-reported physician-diagnosed Type 2 diabetes in a population aged 45-74 years from five German regions. METHODS Study participants were linked via their addresses at baseline to particular neighbourhoods. Individual-level data from five population-based studies were pooled and combined with contextual data on neighbourhood unemployment. Type 2 diabetes was assessed according to a self-reported physician diagnosis of diabetes. We estimated proportional hazard models (Weibull distribution) in order to obtain hazard ratios and 95% CIs of Type 2 diabetes mellitus, taking into account interval-censoring and clustering. RESULTS We included 7250 participants residing in 228 inner city neighbourhoods in five German regions in our analysis. The incidence rate was 12.6 per 1000 person-years (95% CI 11.4-13.8). The risk of Type 2 diabetes mellitus was higher in men [hazard ratio 1.79 (95% CI 1.47-2.18)] than in women and higher in people with a low education level [hazard ratio 1.55 (95% CI 1.18-2.02)] than in those with a high education level. Independently of individual-level characteristics, we found a higher risk of Type 2 diabetes mellitus in neighbourhoods with high levels of unemployment [quintile 5; hazard ratio 1.72 (95% CI 1.23-2.42)] than in neighbourhoods with low unemployment (quintile 1). CONCLUSIONS Low education level and high neighbourhood unemployment were independently associated with an elevated risk of Type 2 diabetes mellitus. Studies examining the impact of the residential environment on Type 2 diabetes mellitus will provide knowledge that is essential for the identification of high-risk populations.
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Affiliation(s)
- G Müller
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - J Wellmann
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - S Hartwig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K H Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - S Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - S Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre of Cardiovascular Research, Site Greifswald, Germany
| | - W Maier
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - C Meisinger
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany
| | - T Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
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10
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Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Ladwig KH, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Tamayo T, Rathmann W, Holle R. Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups. J Diabetes Complications 2015; 29:203-11. [PMID: 25499244 DOI: 10.1016/j.jdiacomp.2014.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 01/14/2023]
Abstract
AIM This study compares health-related quality of life (HRQL) in patients with type 2 diabetes (T2DM) across treatment groups and explores gender differences. METHODS Four regional surveys (KORA, CARLA, SHIP, DHS) and a national survey (GNHIES98) were pooled at individual level. HRQL was assessed with the SF-12/-36v1. Linear regression models were used to assess the effect of T2DM by treatment type (no medication; oral; oral/insulin combination; insulin) on the physical (PCS-12) and mental summary score (MCS-12) and the SF-6D, controlling for age, sex, study and covariates. We also performed an explanatory analysis of single items. RESULTS PCS-12 scores and treatment type were associated (P-value 0.006), with lowest values for insulin treatment (-4.44 vs. oral; -4.41 vs. combination). MCS-12 scores were associated with treatment type and gender (P-value <0.012), with lower scores for women undergoing oral (-4.25 vs. men) and combination treatment (-6.99 vs. men). Similar results were observed for SF-6D utilities and single items, related to mental health, social functioning, vitality and role limitation (emotional). Comorbidities were predictors of lower PCS-12 and SF-6D scores. CONCLUSIONS T2DM treatment impacts differently on physical and mental HRQL and on women and men. Further studies of gender-specific perceptions of T2DM treatment regimens are needed.
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Affiliation(s)
- M Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - P Reitmeir
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - S Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
| | - C Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K H Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany; German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - G Müller
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - U Ellert
- Department of Epidemiology and Health Reporting, Robert-Koch-Institute, Berlin, Germany
| | - H Neuhauser
- Department of Epidemiology and Health Reporting, Robert-Koch-Institute, Berlin, Germany
| | - T Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
| | - R Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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11
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Dragano N, Halina Greiser K. Workshop ‚Nationale Kohorte': Welche Möglichkeiten bietet die Nationale Kohorte der Forschung zu psychosozialen Faktoren? Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Hartwig S, Kuss O, Tiller D, Greiser KH, Schulze MB, Dierkes J, Werdan K, Haerting J, Kluttig A. Validation of the German Diabetes Risk Score within a population-based representative cohort. Diabet Med 2013; 30:1047-53. [PMID: 23586438 DOI: 10.1111/dme.12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 01/27/2023]
Abstract
AIM To validate the German Diabetes Risk Score within the population-based cohort of the Cardiovascular Disease - Living and Ageing in Halle (CARLA) study. METHODS The sample included 582 women and 719 men, aged 45-83 years, who did not have diabetes at baseline. The individual risk of every participant was calculated using the German Diabetes Risk Score, which was modified for 4 years of follow-up. Predicted probabilities and observed outcomes were compared using Hosmer-Lemeshow goodness-of-fit tests and receiver-operator characteristic analyses. Changes in prediction power were investigated by expanding the German Diabetes Risk Score to include metabolic variables and by subgroup analyses. RESULTS We found 58 cases of incident diabetes. The median 4-year probability of developing diabetes based on the German Diabetes Risk Score was 6.5%. The observed and predicted probabilities of developing diabetes were similar, although estimation was imprecise owing to the small number of cases, and the Hosmer-Lemeshow test returned a poor correlation (chi-squared = 55.3; P = 5.8*10⁻¹²). The area under the receiver-operator characteristic curve (AUC) was 0.70 (95% CI 0.64-0.77), and after excluding participants ≥66 years old, the AUC increased to 0.77 (95% CI 0.70-0.84). Consideration of glycaemic diagnostic variables, in addition to self-reported diabetes, reduced the AUC to 0.65 (95% CI 0.58-0.71). A new model that included the German Diabetes Risk Score and blood glucose concentration (AUC 0.81; 95% CI 0.76-0.86) or HbA(1c) concentration (AUC 0.84; 95% CI 0.80-0.91) was found to peform better. CONCLUSIONS Application of the German Diabetes Risk Score in the CARLA cohort did not reproduce the findings in the European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam study, which may be explained by cohort differences and model overfit in the latter; however, a high score does provide an indication of increased risk of diabetes.
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Affiliation(s)
- S Hartwig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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13
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Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, Kluttig A, Völzke H, Schipf S, Moebus S, Bokhof B, Berger K, Mueller G, Rathmann W, Tamayo T, Mielck A. The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med 2013; 30:e78-86. [PMID: 23127142 DOI: 10.1111/dme.12062] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 09/28/2012] [Accepted: 10/31/2012] [Indexed: 01/09/2023]
Abstract
AIM Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio-economic status. METHODS We pooled cross-sectional data from five German population-based studies. The data set contained information on n = 11,688 study participants (men 50.1%) aged 45-74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio-economic status and regional deprivation, based on a new small-area deprivation measure, the German Index of Multiple Deprivation. RESULTS Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation [OR 1.88 (95% CI 1.16-3.04) in quintile 4 and OR 2.14 (95% CI 1.29-3.55) in quintile 5 compared with the least deprived quintile 1], even after controlling for individual socio-economic status. Focusing on individual socio-economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level [OR 1.46 (95% CI 1.24-1.71)] and for the lowest compared with the highest income group [OR 1.53 (95% CI 1.18-1.99)]. CONCLUSION Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio-economic status. The results of the present study could help to target public health measures in deprived regions.
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Affiliation(s)
- W Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
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14
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Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, Meisinger C, Thorand B, Berger K, Mueller G, Moebus S, Bokhof B, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Rathmann W, Völzke H. Regional differences in the prevalence of known Type 2 diabetes mellitus in 45-74 years old individuals: results from six population-based studies in Germany (DIAB-CORE Consortium). Diabet Med 2012; 29:e88-95. [PMID: 22248078 DOI: 10.1111/j.1464-5491.2012.03578.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health-care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents. METHODS Data of subjects aged 45-74 years from five regional population-based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self-reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007). RESULTS Of the 11,688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1-9.1%). For the nationwide study, a prevalence of 8.2% (7.3-9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9-10.4%) than in women (7.6%; 6.9-8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3-13.7%) and lowest in the south with 5.8% (4.9-6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%). CONCLUSION The prevalence of known Type 2 diabetes showed a southwest-to-northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
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Affiliation(s)
- S Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany.
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15
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Hardt J, Brendler C, Greiser KH, Timmer A, Seidler A, Weikert C, Latza U. [Directed acyclic graphs (DAGs) - basic concepts and application of an approach for causal analyses in epidemiology]. Gesundheitswesen 2011; 73:878-9. [PMID: 22193895 DOI: 10.1055/s-0031-1287844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, Meisinger C, Thorand B, Berger K, Müller G, Moebus S, Bokhof B, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Rathmann W, Völzke H. Neue Ergebnisse zur Epidemiologie des Typ 2 Diabetes – Süd-Nord-Gradient in der Prävalenz des bekannten Typ 2 Diabetes in Deutschland (DIAB-CORE Verbund). DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Schunk M, Reitmeir P, Schipf S, Völzke H, Meisinger C, Thorand B, Kluttig A, Greiser KH, Berger K, Müller G, Ellert U, Neuhauser H, Tamayo T, Rathmann W, Holle R. Gesundheitsbezogene Lebensqualität von Personen mit und ohne Typ 2 Diabetes: gepoolte Analyse von fünf bevölkerungsbasierten Studien aus Deutschland (DIAB-CORE Verbund). DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Leisure-time physical activity is associated with better health and a reduced risk of all-cause mortality. It is unclear if this association is also present with a high level of physical activity as it is found in professional athletes. In a population-based retrospective cohort study, we compared the survival experience of all soccer players participating for Germany in international matches between 1908 and 2006 to that of the general population. To summarize survival experience, we calculated cumulative relative survival ratios (RSRs) from a life table. We included data of 812 international players, of which 428 (=52.7%) died during follow-up. In all 13 intervals, cumulative observed survival was smaller than cumulative expected survival, resulting in cumulative RSRs being <1. The cumulative RSRs are statistically significantly different from 1 in all but the last interval. This impaired survival experience of the internationals translates into a loss of median residual lifetime of 1.9 years [95% confidence interval: 0.6, 3.2] years at the entry time into the cohort. This loss is mainly driven by the mortality of internationals from the earlier half of the observation period. Reasons for this might be poorer medical care in former times, internationals being killed in action during World War II, and a changing distribution of causes of death during the 20th century.
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Affiliation(s)
- O Kuss
- Institute of Medical Epidemiology, Biostatistics, and Informatics, University of Halle-Wittenberg, Halle (Saale), Germany.
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19
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Schipf S, Werner A, Holle R, Schunk M, Meisinger C, Thorand B, Berger K, Moebus S, Bokhof B, Mielck A, Kluttig A, Greiser KH, Neuhauser H, Ellert U, Icks A, Tamayo T, Rathmann W, Völzke H. Regionale Unterschiede in der Prävalenz des Typ 2-Diabetes mellitus: Ergebnisse aus sechs populationsbasierten Studien in Deutschland (DIAB-CORE). DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Hoffmann W, Latza U, Ahrens W, Greiser KH, Kroke A, Nieters A, Schulze MB, Steiner M, Terschüren C, Wjst M. [Biological Markers in Epidemiology: Concepts, applications, Perspectives (Part II)]. Gesundheitswesen 2002; 64:145-52. [PMID: 11904855 DOI: 10.1055/s-2002-22313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The first part of this paper outlined terms and definitions in the context of the application of biological markers in epidemiological studies. Cardiovascular epidemiology served as an example for their historical development. The second part focusses on DNA-based biomarkers, practical and methodological dimensions of the use of biomarkers in analytic epidemiological studies as well as requirements in respect of validity and quality assurance. Most genetic polymorphisms have no impact on health. However, some can be used as biomarkers for individual sensitvity to exposures and susceptibility for specific diseases. The Human Genome Project has brought about a quantum leap in the development of genetic markers. The practical implications cannot presently be assessed with certainty. However, present and future research programmes of gene-environment interactions depend on "traditional" epidemiological study designs, methods, and concepts. Ethical principles and data protection requirements apply equally to genetic and molecular epidemiology as do the "Guidelines for Good Epidemiological Practice".
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Affiliation(s)
- W Hoffmann
- Bremer Institut für Präventions, forschung und Sozialmedizin, Linzer Strasse, Bremen, Germany.
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21
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Hoffmann W, Latza U, Ahrens W, Greiser KH, Kroke A, Nieters A, Schulze MB, Steiner M, Terschüren C, Wjst M. [Biological markers in epidemiology: concepts, applications, perspectives (part I)]. Gesundheitswesen 2002; 64:99-107. [PMID: 11904849 DOI: 10.1055/s-2002-20274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The inclusion of biomarkers in epidemiological research provides new possibilities for exposure assessment and the study of early structural or functional changes and pre-clinical stages of diseases. At the same time issues of validity, reliability, and quality control as well as logistics require special attention. Usually epidemiological studies become more expensive with regard to time and cost. Interdisciplinary collaboration between epidemiology, basic research, and laboratory research is crucial. A prerequisite for this collaboration are agreements on definitions, methods and procedures. The definition of "biomarker" and a description of previous uses of biomarkers in epidemiological studies are presented in the first part of this paper. The second part addresses genetic markers and markers of individual sensitivity and susceptibility. We will end with a discussion about the possible future of biomarkers in epidemiology.
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Affiliation(s)
- W Hoffmann
- Bremer Institut für Präventonsforschung und Sozialmedizin, Linzer, Strasse, Bremen
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